Add to "My indicators"
Average additional amount of micronutrients delivered daily by consumption of fortified flour
This indicator describes documentation of the additional nutrients ingested by consumers due to intake of flour that, by law or standards, should be fortified. Among the target population, this can be expressed as the average intake over a 24-hour period for any nutrient added through fortification of flour. This indicator refers to the ingestion of nutrients from foods made with fortified flour, not from all foods in the diet.
The purpose of large-scale flour fortification is to improve the nutrition and health status of the target population(s). Upon implementation of a flour fortification programme, the population’s intake of each micronutrient added to flour as a fortificant is expected to increase. This should, in turn, improve the population’s nutrition status, which will ultimately result in better health and functional outcomes and reduced morbidity and mortality. Assessing the intake of nutrients added to flour through fortification reflects exposure to the intervention and is useful for gauging the programme’s expected impact. Examining changes in the average nutrient intakes among the target population may be a key outcome variable for mature programmes.
To calculate the additional micronutrients delivered by flour, the results from two indicators are used:
• Micronutrient content of fortified flour: the average additional nutrient content in the fortified flour that was targeted by the survey.
• Fortified flour intake: the average amount of fortified flour consumed by the individual or household targeted for the survey.
Specifically, the micronutrient content of fortified flour is multiplied by the fortified flour intake to calculate the micronutrient intake from fortified flour.
Considerations for the calculation:
• To determine nutrient intakes, two sources of information must be used: 1) an estimate of the amount of flour consumed over a one-day period of time, and 2) the additional nutrients provided by fortified flour.
• If flour samples will be analyzed, the native (intrinsic) content of nutrients in the unfortified flour must be subtracted from the fortified flour. Otherwise, the sole contribution of fortification cannot be estimated.
• Multiple micronutrients are often included in the premix that is added to flour during fortification. Every nutrient is reported in different units; for example, iron and zinc intake are reported in milligrams, while folic acid, vitamin B12, and vitamin A intakes are reported in micrograms.
• The indicator can be reported separately for any nutrient added to fortify the flour.
• If multiple days of nutrient intake are assessed for each individual, then the sum of an individual’s intake can be averaged over all the days and that value used.
• It may be desirable to compare micronutrient intake from fortified flour against national or international recommendations to assess the contribution of fortification.
consumption, consumption monitoring, diet, household monitoring, individual monitoring, intake, nutrients, micronutrient utilization,ingest
Food fortification
Outcome
Improved intake of vitamins and minerals
School age children, 12-23 months, 24-35 months, 36-47 months, 48-59 months, 6-11 months, Adolescents, Men, Women of reproductive age
None,
All
Market-based
• Fortified flour programmes may target beneficiaries, such as women of reproductive age. If such beneficiaries are specified in the programme documentation (such as legislation and regulations), they should be the focus of the analysis.
• By law, not all types of flour may require fortification with vitamins and minerals. Therefore, it is important to document intake only of the flour types that are supposed to be fortified.
• Ideally, nutrients will be analysed in a laboratory that is ISO 17025-certified in the analysis of all nutrients of interest, the laboratory will have experience with measuring nutrients in the flour samples to be collected, and all nutrients that are required to be added to the flour are quantified.
This key indicator quantifies nutrient intake using appropriate quantitative dietary assessment methods. It provides an indication of the quantity of nutrients consumed by targeted beneficiaries through fortification of flour.
• Reported dietary intake can suffer from reporting bias.
• Analyzing food samples requires human and material resources.
• Identifying and updating food composition tables for the country, if not already available, may be costly, time-consuming, and burdensome.
• Validly collecting and calculating this indicator requires expertise that might not be readily available in all countries.
In a survey of 550 households, one woman of reproductive age was selected to participate per household. Women were asked the amount of flour they used over a 7-day period. Import monitoring information was used to estimate the amount of nutrients in the flour consumed.
In the example below, the focus was on zinc. The average additional content of zinc in fortified flour was estimated to be 50 mg/kg by a laboratory commissioned to analyze imported flour samples.
In one surveyed household, the amount of fortified flour consumed by a woman totaled 75 grams/day. For this woman, the “additional zinc delivered by consumption of fortified flour” was as follows, taking into account that 1 kg contains 1000 grams.
Calculation: 75 grams of flour / day * 50 mg of zinc / kg * 1 kg / 1000 g flour = 3.8 mg zinc per day from fortified flour
.
1. Willett W, editor. Nutritional epidemiology, 3rd edition. New York: Oxford University Press; 2013.
2. International Network of Food Data Systems (INFOODS) [website]. Rome: Food and Agriculture Organization of the United Nations; 2021 (http://www.fao.org/infoods/infoods/en/, accessed 16 April 2021).